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s llil111111iI�Ellll�li��I�111111f�1f�111�1l1111I1��llllll��ll111111�1 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL00026.s335 3 (800)326-1221 5gi ffVERSE LOGISTICS SPECIALIST / �° N '�R n�rErL!'9a LEAD/REV. LOG. t t, NAt3L LCG TRACY, C14 95.304 TRACY CA 95304 (209)333-3494 GEN: 12961 Generators Phone. 6.Transporter I Company Name U S.EPA ID Number HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 7 Transporter 2 Company Name U.S EPA ID Number e. 1 Tf ftM"TAL SERVICES LLC U.S.EPA ID Number 284 E STOREY RD AZD081705402, COOLIDGE, AZ 85228 Facility's Phone: (520)723-4167 9a 9b.U S DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group(if any)) No. Type Quantity WI Nol o X ' RQ UN1057,WASTE LIGHTERS,2. 1, (D001), 1 331 001 ERG#1'15 O` P Dix I US X 2 R091UN1950 WASTE AEROSOLS, FLA ABLE, ' D001 331 N.O.S. , .S. ,2. 1, ( ?001),ERG#126 X 3 - , +1-i4X WAI 113'a "'�FR,#1 r 1 4-44- r., :W1cHbJI � °sLr�OAcidro°c I at�J12104_LDR --Wt 2 --,_ R r c lac, 11K Ix2o 11288938713 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name.and are classified,packaged, marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. TGei r erors nt ame a e on ay f ear v-! J 16 International Shipments F— ❑Import to U S 0 Export from U.S. Port of entry/exit Transporter signature for exports onlyDate leaving U.S.: W 17.Transporter Acknowiedgment of Receipt of Materials Transporter 1 Printed!Typed Nam Signature on ay Year a QTransporter 2 Printed/Typed Name Monthay Year rY H 18 Discrepancy 18a Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Altemate Facility(or Generator) U.S.EPA ID Number J U Q LL FacilA s Phone. W 18c Signature of Alternate Facility for Generator) Month Day Year Q Z 19,Hazardous Waste Report Management Method Codes(i e.codes for hazardous waste treatment.disposal.and recycling systems) LU ' H141 2. H141 3 - } a -- 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PriMed/TypedName Signature Month Day Year { Glit �c 6;" 7. -e— cit EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)